title: Adverse events among Ontario home care clients associated with emergency room visit or hospitalization: a retrospective cohort study.
abstract: BACKGROUND
  Home care (HC) is a critical component of the ongoing restructuring of healthcare in Canada. It impacts three dimensions of healthcare delivery: primary healthcare, chronic disease management, and aging at home strategies. The purpose of our study is to investigate a significant safety dimension of HC, the occurrence of adverse events and their related outcomes. The study reports on the incidence of HC adverse events, the magnitude of the events, the types of events that occur, and the consequences experienced by HC clients in the province of Ontario.
  
  
  METHODS
  A retrospective cohort design was used, utilizing comprehensive secondary databases available for Ontario HC clients from the years 2008 and 2009. The data were derived from the Canadian Home Care Reporting System, the Hospital Discharge Abstract Database, the National Ambulatory Care Reporting System, the Ontario Mental Health Reporting System, and the Continuing Care Reporting System. Descriptive analysis was used to identify the type and frequency of the adverse events recorded and the consequences of the events. Logistic regression analysis was used to examine the association between the events and their consequences.
  
  
  RESULTS
  The study found that the incident rate for adverse events for the HC clients included in the cohort was 13%. The most frequent adverse events identified in the databases were injurious falls, injuries from other than a fall, and medication-related incidents. With respect to outcomes, we determined that an injurious fall was associated with a significant increase in the odds of a client requiring long-term-care facility admission and of client death. We further determined that three types of events, delirium, sepsis, and medication-related incidents were associated directly with an increase in the odds of client death.
  
  
  CONCLUSIONS
  Our study concludes that 13% of clients in homecare experience an adverse event annually. We also determined that an injurious fall was the most frequent of the adverse events and was associated with increased admission to long-term care or death. We recommend the use of tools that are presently available in Canada, such as the Resident Assessment Instrument and its Clinical Assessment Protocols, for assessing and mitigating the risk of an adverse event occurring.
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8, Canada. diane.doran@utoronto.ca
authors.forename: Diane M
authors.initials: DM
authors.lastname: Doran
authors.forename: John P
authors.initials: JP
authors.lastname: Hirdes
authors.forename: Regis
authors.initials: R
authors.lastname: Blais
authors.forename: G Ross
authors.initials: GR
authors.lastname: Baker
authors.forename: Jeff W
authors.initials: JW
authors.lastname: Poss
authors.forename: Xiaoqiang
authors.initials: X
authors.lastname: Li
authors.forename: Donna
authors.initials: D
authors.lastname: Dill
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.forename: George
authors.initials: G
authors.lastname: Heckman
authors.forename: Hélène
authors.initials: H
authors.lastname: Lacroix
authors.forename: Lori
authors.initials: L
authors.lastname: Mitchell
authors.forename: Maeve
authors.initials: M
authors.lastname: O'Beirne
authors.forename: Nancy
authors.initials: N
authors.lastname: White
authors.forename: Lisa
authors.initials: L
authors.lastname: Droppo
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Foebel
authors.forename: Gan
authors.initials: G
authors.lastname: Qian
authors.forename: Sang-Myong
authors.initials: SM
authors.lastname: Nahm
authors.forename: Odilia
authors.initials: O
authors.lastname: Yim
authors.forename: Corrine
authors.initials: C
authors.lastname: McIsaac
authors.forename: Micaela
authors.initials: M
authors.lastname: Jantzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000639:trends*; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D012189:Retrospective Studies